We inspected St Gemmas Hospice on 13 July 2016 and then returned on 19 July 2016 to provide feedback to the registered provider. The first day was unannounced which meant that the staff and registered provider did not know we would be visiting. The second day was made by appointment. At the last inspection in November 2013 the service was meeting the regulations we looked at.

St Gemma’s Hospice (in patient unit) provides specialist palliative and end of life care to a maximum number of 32 people. The service also supports around 200 people in the community. At the time of our inspection visit there were 26 people who used the in patient service.

The hospice had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us there were enough staff to meet their needs and keep them safe. Staff had the extensive knowledge, information and support to ensure people were kept safe from abuse. Staff told us they would report any concerns to the nurse in charge or the registered manager. There was a ‘no blame’ culture with staff encouraged to report any clinical incidents or accidents. These were fully investigated and used as a learning tool to drive improvements in the delivery of care and safeguard people from harm.

Staff understood people’s individual needs and the support they and their family members required. Staff were passionate about their roles and placed people at the heart of their work. We saw that care was provided with the utmost kindness, respect and compassion. People who used the service and relatives spoke very highly about the care and service they received. People said their right to privacy was fully protected within the hospice .Families of people told us the end of life care their relatives had received was excellent. People had their wishes documented in their care plans and there was clear evidence that these wishes had been carried out. One member of staff told us, “One gentleman wanted to die in Scotland this was in his care plan. We had to make so many calls to find somewhere who could continue his care, but we did it. A nurse flew up to Scotland with him to ensure he was settled in the hospice and we were proud to know he got his last wish.” The hospice provided excellent family support, counselling and bereavement support within and outside the hospice.

Meals were produced specifically for each individual to their own taste. People could have meals when they wished and could request anything they wanted to eat. People’s cultural and religious needs were taken into account when preparing any meals. Staff told us meals were so important to people that they tailored them to what people wanted. Comments included: “The menus are extensive and there are no set meal times, you eat when you want to.” “The food is superb, you can have whatever you choose and at whatever time you feel like eating.” Nutritional assessments were undertaken to identify risks associated with eating and drinking. Referrals were made to the appropriate professionals.

People received care from a multi-disciplinary staff team who were qualified to a high standard and supported and trained to meet their individual needs. There was a very proactive approach to the personal development of staff and the acquiring of new skills and qualifications. A system of competency based assessments ensured staff could demonstrate the required knowledge and skills to meet people’s needs effectively. Staff received supervision and support.

A well-established pharmacy team provided good clinical services to ensure people’s medicines were managed safely. The team regularly attended clinical meetings to discuss people’s indivi

People who used the service said they were happy with their care, treatment and support. Comments included:

"I can't praise this place high enough.”

"From day one care has been superb.”

People said the meals were good and food, snacks and drinks were available at any time of day for them. Comments we received included:

“Fares pretty well.”

“The meals are superb.”

We saw that people who used the service were responded to promptly when they asked for any support or assistance. People who used the service said there were enough staff. They were also very complimentary about the staff. One person said, "Never had any staff we've not taken to." Another said, "All have been kind, caring and considerate.”

We saw there were effective recruitment procedures in place.

There were systems in place to ensure people were protected because accurate and appropriate records were maintained.

People who used the service said they were happy with their care, treatment and support. They said they were well looked after. People said they understood their care and support and that staff had explained things well to them.

People’s comments included:

“Lovely bedside manner from all staff, everything always explained really well.”

“Couldn’t come to a better place.”

“Treated like royalty here.”

“Can’t fault the care and attention from all staff.”

We saw that people who used the service were responded to promptly when they asked for any support or assistance

We saw that people received care and support in an environment that was safe and well maintained to a very high standard. People who used the service were very complimentary about the environment. One person said, “It’s so lovely here and so clean, they are always cleaning and making it nice.”

People who used the service said there were enough staff. They were also very complimentary about the staff. Their comments included: “Excellent staff” and “The staff are so kind and caring.”

People told us they would speak to staff if they had any concerns. They said they felt confident and comfortable to do so.

During the visit we spoke to four people using the service. They told us they were very happy with the care and treatment they received at St. Gemma’s. They said they were involved in decisions about their care and treatment. People told us all the staff were kind and attentive, they said when they called for help staff responded quickly. People said the food was very good, they said the menu was varied and they were able to have their meals at times that suited them. They said the environment and facilities were good and it was always clean.